Provider Demographics
NPI:1508417726
Name:BOLDING, KATHY L (OTD)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:L
Last Name:BOLDING
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 SIERRA DR
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-2742
Mailing Address - Country:US
Mailing Address - Phone:307-349-7583
Mailing Address - Fax:
Practice Address - Street 1:901 S GREELEY HWY
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82007-3019
Practice Address - Country:US
Practice Address - Phone:307-634-2109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-28
Last Update Date:2019-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOT-330225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist